Cryptococcus laurentii Fungaemia in a Neonate from Nigeria: A Case Report

Abstract

Aim: Increasing cases of Cryptococcus laurentii infection are being reported globally possibly due to advances in medicine, the use of immunosuppressants and invasive therapies such as endotracheal intubation, parenteral nutrition, central vascular catheters and exposure to broad-spectrum antimicrobial agents. Cryptococcus species are ubiquitously distributed in the environment, abundant in contaminated soil and bird droppings. Four cases of Cryptococcus laurentii fungemia have been described in neonates, all were premature low/very low-birth-weight. Our case is likely the 5th reported globally and the 1st from Nigeria and Africa across all age groups. Case Presentation: The patient presented at 34 hours of life with complaints of fever and multiple convulsions after delivery in a traditional birth attendant facility. Mother drained liquor for 5 days with poor cord care. A diagnosis of severe birth asphyxia with sepsis was made and baby received antibiotics (ceftriaxone and genticin) in addition to the management of severe birth asphyxia but showed no improvement. Blood culture yielded cream-colored smooth colonies, identified by Vitek 2 (bioMerieux, France) as Cryptococcus laurentii. Baby was treated with fluconazole, had good recovery and was discharged home. Conclusion: Our case report emphasizes the need for high index of suspicion for non-bacterial organisms (fungi) as possible causes of sepsis in newborns. Improved fungal diagnosis and timely commencement of antifungal medications will improve clinical outcomes.